E045 Clinical triage: Investing in the front door

Abstract

Abstract Background/Aims The processes and IT systems that support the referral pathway are complex. The focus on referral optimisation and out-patient transformation has provided an opportunity to do things differently. Getting It Right First Time recommendations highlight the importance of ensuring rheumatologists focus on conditions which require specialist rheumatology input. As part of an integrated musculoskeletal (MSK) service we are able to redirect referrals regarding non-inflammatory conditions to our MSK and Community Pain teams. This project evaluates the impact of clinical triage. Methods Consultant-led triage introduced in July 2021. Directory of services updated and met with primary care networks leads to inform them of the changes. Letter co-designed with GPs to send out to patients when referral responded to with immediate specialist advice. Triage job planned with an allocation of 45 minutes per day. Referrals are reviewed on the electronic referral system and accepted, returned or redirected to another service. Standard responses developed to ensure consistency. All triage outcomes recorded in a spreadsheet. Review undertaken of returned referrals to identify any patients who were re-referred. To ascertain the proportion of patients triaged to early inflammatory arthritis (EIA) appointments who were diagnosed with an EIA, National Early Inflammatory Arthritis Audit data was analysed before and after changes to triage. Results Between January and June 2022 we received 1194 referrals; 761 (64%) were accepted, 289 (24%) returned, 43 (4%) redirected to another service and 73 (6%) returned with immediate specialist advice. Of the 289 referrals that were returned, 74 (25%) were returned for more information, 61 (21%) with a request to examine the patient, 118 (41%) were deemed inappropriate, 14 (4%) were patients already under our care and 22 (8%) were returned for other reasons. We received a further referral for 46/74 of those returned for more information, 45/61 following the request to examine the patient, 13/118 of those returned as not felt appropriate and 3/73 of those returned with immediate specialist advice. In total, we saved 278 new patient appointments over a 6-month period. Allowing for the time job planned, this was a net gain of 6 new patient appointments a week. In 2019, 37% of patients seen in an EIA appointment were diagnosed with an EIA compared to 51% in 2022. Conclusion Investment in clinical triage has saved a considerable number of appointments. For some patients it has provided an immediate specialist opinion or redirected them to a more appropriate service. It has helped to ensure that we are seeing patients who require specialist rheumatology input. Next steps are to share this work more widely and develop resources for patients and primary care to help promote a different way of working and delivering specialist advice. Disclosure E. MacPhie: None. S.M. Fish: None. A. Madan: None. C. Rao: None. S. Horton: None.